160 MAGNOLIA ST - WINDOW (2) S►,� r
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CITY OF ATLANTIC BEACH
Is f 800 SEMINOLE ROAD
1-tr t ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-793
Job Type: WINDOW AND/OR DOOR
Description: REPLACE TWO WINDOWS
Estimated Value: $500.00
Issue Date: 4/7/2016
Expiration Date: 10/4/2016
PROPERTY ADDRESS:
Address: 160 MAGNOLIA ST
RE Number: 170616-5000
PROPERTY OWNER:
Name: SOUMIS, GABRIEL
Address: 160 MAGNOLIA ST
GENERAL CONTRACTOR INFORMATION:
Name: JUSTIN LARSEN CONSTRUCTION INC
Address: PO BOX 1942 LIC # BELOW 4 GERALD GOLLOBIT
Phone: 904-327-4311
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $27.50
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
(,,,,,„,p,..,„ City of Atlantic Beach APPLICATION NUMBER
IA Building Department (To be assigned by the Building Department.)
-: - 800 Seminole Road 1 CO -. 1'r1 _ 7c 2
'IA Vt4 ( J
j_, ,. Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
F J,3 o E-mail: building-dept @coab.us Date routed: 4 5/1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I 670 MA6.NOLI A ST De• - • iient review required Ye No
Buildin•
Applicant: �E.,. Li i SE'- 0 pi `,° Planning &Zoning
Tree Administrator
Project: \&J £ otic) R EP(C., Public Works
Public Utilities
C ( v C2)1 Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: roved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING `" •�•6 6_m______V
Reviewed by: Date:
TREE ADMIN. Second Review: ['Approved as revised. ❑Den d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION FILE COP '
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845 ((p-.W I j)(:),-;79
Job Address /Go /1'4yr2oIlh S-1 "Air /3tcc,(,, a33 Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. q, t
Valuation of Work$,..572, Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa indow/.oor
Use of existing/proposed s cture(s) (circle one Commercial Residential
If an existing structure, '. a fire sprinkler s ste stalled? (Circle one): Yes No N/A
Florida Product Approv.1#
For multiple products e product approv. r'orm
Describe in detail the type of work to be performed: /1.4“4, , �, 62.
• Property Owner Information:
Name:J/Af)d 6/0•14/5 Address:A' 1k) Mai cc. S1-
city At 4014,1 lc 4 eac k State PLZip X33 Phone L f '/-Z63-,53.1
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: 3� „s .y,._ Qualifying ent:
Address:0 ,3- /. City /4 State—FL_—Zip
Office Phone f t,J J l3ii Job S e/Contact Number f49.-/05--,2 Dl Fax#
State Certification/Registration# (tee 3a9 F y7
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, Furnaces ,Boilers,Healers,
Tanks and Air Conditioners,etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby cert that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o1 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
7rovisions of any other federal,s r locallaw regulating construction or the performance of construction.
DAVID NATHAN SLATOFF
signature of Owner Y IssION ss 43111,e of Contracto. -- _
., EXPIRES November
sa 09.2019
'rint Name X g rlliI SCAM/L15 Flona,Nq, yservio D'int
Name , r
3efore me Before me
is ej___Day of ' 2 this _ Day of A+r
i►►��
,' ; DAVID NA • ,td,
, .�ri 116 �1/� • ••: My c i
Tota"'u. • ' a Pr :ryPu. • 'I"— EXPIRES• •
. .10 --+
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FILE COPY Page 1 of 1
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Print Date: 4/4/2016 4:14:03
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Transaction#: 2998585 ,��r,a,-
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Receipt#: 2914698
Cashier Date: 4/4/2016 Ronnie Fussell
4:14:02 PM Clerk Circuit Court
(KJEWELL) Duval County
501 West Adams St RM 1051
Jacksonville, FL 32202
(904) 255-2000
Customer Information Transaction Information Payment Summary
DateReceived: 04/04/2016
Source Code: BEACH
Q Code: BEACH
0 J E LARSEN CONSTRUCTION INC Over the Total Fees $10.00
Return Code:Counter Total Payments $10.00
Trans Type: Recording
Agent Ref
Num:
1 Payments
I• ! $10.00
rP1 CHECK 2173
1 Recorded Items
BK/PG: 17514/1111 CFN:2016074435
(N/C) NOTICE COMMENCEMENT Date:4/4/2016 4:13:56 PM
From: SOUMIS GABRIEL To: J E LARSEN
CONSTRUCTION INC
INDEXING 2 $0.00
RECORDING 1 $10.00
10 Search Items I
10 Miscellaneous Items I
file:///C:/Program%20Files/RecordingModule/default.htm 4/4/2016
NOTICE OF COMMENCEMENT FILE COPY
y►, (PREPARE IN DUPLICATE)
Permit No. /6 . r�tf/)2 D —797 7 17 Tax Folio No.
State of 5=L. County of ,U
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: /a /6-,•;1 c94 -075
�GE
1747 /" ,J G(-,
Address of property being improvedX `&) ylU/fki 5/ ecte fx. gebr i r f e4d-33
General description of improvements: !/I/la��/Tw (2
Owner x 64b(lt,J
Address 160 mGt<t 491ICt S1 ►•(T1Gt✓I1iC t�&ctd t F( 33
Owner's interest in site of the improvement X
Fee Simple Titleholder(if other than owner)
Name
Address
r
Contractor ' �
Address /�7/� /4 '' /75_ jf /i�ZI tai TZ�, c
Phone No. �7y g,,27 X.41 Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY 1, OWNER
SignV _ Zl j/
DATe I l
Before me this 71.%ay of In the
Doc#2016074435,OR BK 17514 Page 1111, County of
Number Pages:1 h rein by
himself/hen- '- at a I s atementn and dec ara Ion s here in
Recorded 04/04/2016 at 04:13 PM, are true an/abxu **•'r MY COMMISSION N FF935021
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
«
COUNTY EXPIRES November 09,2019
RECORDING$10.00 ■ecri-�w o•sa seprdgreob•ySp pe.,�pm
Notary Public at Large.State of fL- , County of .�•_.�
My commission expires: - . —_ •
Personally Known �I ��1�r�
Produced Identl ica on /410"7�//�/j�